Six Effective PAIN MANAGEMENT STRATEGIES

There are a number of strategies that you can learn to help you to manage pain more effectively. The following is a list of six strategies that you can try. These strategies may seen like simple changes, but if you give each a fair try and practice the strategies below it could have a significant impact on your level of pain and activity.

1. Set Goals and Keep Moving

One of the first things that I do when working with a patient who has chronic pain is set goals for treatment. These are not goals like "have less pain" or "become a better person". The goals that I'm referring to are called "behavioral goals" - these are goals related to things that the patient actually wants to do like reading, picking up an old hobby or developing a new one, having lunch with a friend, taking a class, or getting outside and doing something healthy like walking, fishing, or going to the gym. Goals that include exercise and activity are great for the body and the brain.

Often when I talk about setting goals with my patients they get very excited about being more active, but occasionally I hear, "I'd like to do that but now that I have pain I just can't do that anymore". Perhaps it is true that there are some things he cant do the way he once could, but that doesnt mean he cant do anything at all. It doesnt have to be all-or-nothing. Perhaps she can't walk a mile, but she could take walks and build up endurance by taking small breaks. He can fish from a bridge rather than from a stream. He can teach someone to make the repair rather than doing it himself. The are many ways to be active if a person is willing to accept that its ok to do things differently. People who develop chronic pain will likely never have complete relief from their pain so at some point they have to make a decision on how they will live the rest of their life. They can stop moving and stay on the couch waiting for a good day to be active (which may rarely come) or they can get moving and try to figure out ways of coping with pain while doing things. Either way they will probably have pain but the person who gets moving will enjoy life a whole lot more.

One of the most important parts of setting goals is picking a goal that is meaningful and achievable. If you pick a goal that is too large you will probably feel overwhelmed and give up. The most effective way to achieve a goal is to break the goal into smaller parts so you can work toward a smaler goal each week. For example, if your overall goal is to be able to walk around the block then you might start by just practicing walking to the mailbox and build up your endurance by walking an extra 30 feet every week. Its OK to modify a goal if you change your mind or if you achieve a goal in a short period of time. People are often amazed by the things they can do when they set goals that are reasonable and achievable, and slowly work up to where they want to be. The journey of a thousand miles begins with a single step.

2. Learn how to Relax

Learning to relax is one of easiest and most effective techniques for managing pain. Relaxation can have many benefits such as increased energy, decreased muscle tension and fatigue, improved sleep, lower blood pressure, and decreased pain. Learning to relax doesnt mean that you have to slow down or be less productive. In fact, if you are relaxed you can think more clearly and function better. There are many ways to relax including deep breathing, meditation, progressive muscle relaxation, music, imagery, yoga, tai chi. You should choose the method that fits you the best.

One of the easiest and most effective ways to relax is by practicing taking deep breaths. Although we all breathe, many people have become accustomed to taking short, shallow breaths... just enough to survive (how are you breathing right now?). Have you noticed that when you are stressed it feels good to stop and take a deep breath? You can breathe this way all the time but you just have to get back into the habit of doing it. The diaphram is a dome-shaped muscle located right underneath the ribcage. When you breathe in the diaphram moves down, the stomach moves out, and air is drawn into the lungs. Breathing can be practiced anywhere, no one knows you are doing it, and the benefits are usually very quick.

Here is how to practice:

Step 1: Find a place where you will not be disturbded by kids, roomates, spouses, etc. Turn off all electronic devices and place them off your body. You will want to practice while seated in a chair because if you relax while laying down you may fall asleep and you are not going learn anything if you are asleep. Later on when you get very good at relaxing you can use this technique to help get to sleep.

Step 2: Schedule breathing practice into your life as you would a favorite TV show or a doctor's appointment. Pick the days and the time to practice. Its important to give this a fair try and practice regularly.

Step 3: When you practice you should try to breathe in through your nose for about 2 seconds and out through your mouth. If you find yourself getting dizzy you are taking in too much air so try to breathe more naturally. Focus on your breathing. When other thoughts enter your mind dont get frustrated - just let them go and re-focus on your breathing and notice how that feels. The more you practice the easier it gets to let go of unwanted thoughts.

How do you know if you are doing it right?

One way to check to be sure that you are breathing correctly is by touching your middle finger tips together and then placing your hands on your stomach. If you are breathing deeply your fingers should come apart when you inhale and back together when you exhale. You can also lay down and place a book on your stomach as you breath. When you take a deep breath you will see the book go up and then down when you exhale.

For children it is often beneficial to use a relaxation CD to help guide them through the process. By practicing breathing 3 to 4 times a week for 10 minutes you will gain a greater awareness how you body feels which will allow him/her to “head off” some pains before they get even started.

You might notice that it feels a little "strange" to stop and just focus on your breathing and nothing else for more than just a minute or two. Thats because people are almost always being bombarded by information coming in through their eyes or ears that distracts them from their own thoughts. For example, do you automatically turn on the radio when you get in the car? Do you turn the TV on at home when you are alone? Do you check your iPhone up to the minute you go to bed? You can actually learn a great deal about yourself by disconnecting from everything around you and just paying attention to how your body feels and the types of things you think about.

3. Challenge Negative Thinking

People who have had pain for a long time often report that over time they begin to experience negative thoughts about themselves and the future. If these thougths persist over a long time they can become very resistent to change and they can lead to other problems. Have you ever noticed that when you are frustrated or "stressed out" your pain seems to increase? or how on days when you are experiencing a lot of pain you have less tolerance for minor annoyances? How does your pain change when you are watching a good show on TV or laughing with a friend? There is a connection between your experience of pain and the way you think. Negative thoughts like "I'm worthless, I'm disabled, or this is the worst day ever" can lead to negative emotions like hopelessness or depression which can increase your experience of pain.

"After finding out the cost of the car repairs I could feel my stress level start to rise. This was the last thing I needed today. I was frustrated, angry, and to make matters worse I could feel the pain in my back start to increase."

Since emotions can impact pain, and all emotions are caused by how we think, we need to make sure that our thinking is accurate. Automtic thoughts are thoughts that we have immediately after getting any kind of information. They occur very quickly and unless we make an effort to pay attention to them, we may not even be aware of them. We have automatic thoughts for EVERYTHING that goes on in our world -- even for very trivial kinds of things (e.g., meeting a person for the first time, hearing a new song on the radio). Sometimes automatic thoughts can be very adaptive. For example, if you come home from the store and find that your front door is open and there is broken glass by your door it does'nt take long for you to think "Someone may have broken in - I should call the police". This is an example of an adaptive automatic thought. The problem is that automatic thoughts are not always accurate. They can be based on something we have read, heard, or just made up on our own. Sometimes thoughts that were adaptive in one situation are not adaptive in other situations. For example, for a soldier who is stationed in Iraq or Afganistan an abandoned car on the side of the road may be perceived as an immediate threat (i.e., an IED) and the soldier would wisely avoid that car by driving aggressively; however, the same automatic thought and reaction would not be adaptive once the soldier returns home. Inaccurate thinking can lead to unecessary anxiety, depression, or anger. Automatic thoughts that are biased and inacurate are called "cognitive errors" and there is actually a list of types of thoughts that often get people into trouble.

The first step to taking control over the thoughts that you have is to notice if there are particular types or patterns of thoughts that are more common. Do you tend to overgeneralize ("Everyone is out for themselves"), think you can mind-read or know what a person is thinking (this is not actually possible), jump to conclusions, or see things in a catastrophic manner ("This is the worst day ever!")? If so, those types of automatic thoughts can lead to unnecessary negative emotions and increased pain. Even if you are going through a tough time in your life, letting negative thoughts "spin" in your head is not good for you.

Cognitive restructuring is a method that can be used to recognize automatic thoughts, determine if the thoughts are accurate, and create a more balanced way of thinking that reflects the facts. Cognitive restructuring is a process in which a person; 1) identifies an event that resulted in a negative or unwanted emotion, 2) considers the thoughts and the types of cognitive errors that he was having at the time of the event that led to the emotion 3) evaluates the thought (e.g., What is the evidence for the thought? What is the evidence against the thought?), and 4) if there is more evidence to suggest that the thought might not be true, create a more balanced positive coping thought that is consistent with the facts and evidence. This process is repeated and practiced for several events. As practice continues, individuals gain skill in changing unwanted automatic thoughts and preventing negative emotions. This is a process that usually starts by working through thoughts and responses using a cognitive restructuring worksheet. After continued practice the paper worksheet is no longer needed and restructuring can all be done in your head. Eventually you dont even have to try to restructure thoughts because the thoughts that were causing problems no longer bother you.

4. Scheduling Pleasant Activities

Sometimes when people have chronic pain they stop doing the things they enjoy the most. The reasons people do this can vary - she may feel she can't to do the activities she enjoys anymore they way she once could so why do them at all, she may feel tired and think it s too painful to do anything, or she may be tired of being around people who will ask her questions about her pain like "whats wrong with you? You look fine to me". Whatever the reason, people need to have things in their lives that they enjoy. Otherwise they can become isolated, lethargic, and depressed which can make pain seem even worse. Putting pleasant activities back into your life can require some effort if you are not accustomed to doing fun things. For some people, pleasant activities need to be scheduled back into their lives as if was a standing appointment with their cardiologist that they could not miss. Once the activities are part of a person's life the start being reinforcing all by themselves (they stop being things you have to do, and start being things that you want to do again).

5. Pace yourself

Having chronic pain doesnt mean you have to stop doing the activities you enjoy; however, it may mean that you just have to change the way you do them. For example, you may not be able to cook a full meal in one evening, but by planning ahead you can assemble all the ingredients in advance, break up the prep into smaller parts, and achieve the same outcome without paying for it with intense pain. You may not be able to walk to the corner grocery store like you once could, but if you take small breaks and plan your walk in advance you can still get there without experiencing intense pain afterwards. Some people believe that if they start a project they have to finish it right away. They work on the project non-stop despite the onset of pain. As a result of “pushing through” the pain, the level of pain becomes higher and higher. This can result in severe pain that requires rest for an extended period of time before being able to work again. Once the pain decreases people may feel they have to work extra hard in order to catch up on time lost. They do everything on their “to do” list on that day, only to end up in more pain for days afterwards. This can lead to taking more pain medication than prescribed on a given day. This cycle of work, pain, and rest is very common for individuals who have chronic pain and want to be active and get things done. Finding the balance between being active and taking breaks is key. The solution is to take small breaks before pain begins. You will get more done in the long run and you will avoid days of intense pain because of over-doing it.

6. Improve Sleep

Sleep is essential - its a time for your body to repair itself both physically and psychologically. Most people need about 8 hours of sleep every night in order to feel rested the next day. When factors such as anxiety, depression, or poor sleep habits begin to interfere with sleep the consequences can make a person more vulnerable to all types of psychological and physical issues including fatigue and increased PAIN. While there are a number of sleep medications available on the market today, almost all of them have significant side effects and none are meant to be used as a long term solution to sleep problems. If you are having problems with sleep the first thing to do is to take a close look at your "sleep behaviors" and determine if there are any behaviors that you can modify. The following strategies may seem simple, but by using these strategies you can set yourself up for a better nights sleep.

  • Timing - Establish a set time for going to sleep and waking up and dont get off schedule - even on the weekend. Your body needs to have a consistent rhythm for sleeping. Although you should avoid taking long naps during the day, short "power naps" (5 to 10 minutes) should not interfere with sleep.
  • Sleep Behaviors - Those of you who have kids know that establishing a pre-sleep ritual (i.e., taking a bath, reading a book, or getting a drink of water) can help your kids to gear-down and prepare for sleep. The same principle applies to adults as well. Think about the things you do each night and plan out activities that will help you to prepare to sleep. Eventually your brain will learn that these activities mean that its time to slow down, relax, and sleep. If you cant fall asleep after 15 minutes of being in bed then get out of bed and do something incredibly dull (dont watch TV or surf the internet). Only get back into be when you are tired. By doing this your brain will eventually learn that the bed is a place for sleep - you will learn that when your head hits the pillow its time to sleep and not process your entire day.
  • Environment - Don't watch TV, read, or play with electronic devices why you lay in bed. The bedroom should be dark so purchase some good room darkening shades if necessary and turn around illuminated alarm clocks. Dont go on the internet in bed - in fact, research has shown that the light coming off from your device is so bright that it actually interferes with the production of melatonin and the onset of sleep.
  • Consumption - Don't drink caffeinated beverage 4 to 6 hours before bed. Alcohol may help you relax but it also increases the need to go to the bathroom at night.
  • Mental Control - avoid engaging in mentally stimulating activity before bed including action movies, stimulating conversations, or listening to loud music. Instead, try doing relaxing activities like performing relaxation, yoga, meditation, having relaxing thoughts, or listening to calm music.